空气与二氧化碳气腹腹腔镜胆囊切除术的比较

目的 比较空气与CO2气腹腹腔镜胆囊切除术（1aparoscopic cholecystectomy，LC）的临床效果，探讨空气膨腹介质下LC的临床应用价值。方法2013年7～10月109例胆囊良性疾病按本科手术日分为2组，分别施行空气气腹或c0，气腹LC，前者除使用空气气腹外，余均使用常规的腹腔镜手术设备和操作器械，比较2组手术并发症、疼痛反应、术后住院时间、总住院费用等。结果 2组均顺利完成LC，无中转开腹、严重并发症发生。空气组无一例中转CO2气腹手术，与CO2组比较，空气组术后肩痛发生率低（X^2=4.097，P=0.043）、恶心呕吐发生率低（X^2=4.584，P=0.032）、视觉模拟评分低（t=-3.568，P=0.000）、术后排气时间短（Z=-4.287，P=0.000）、术后住院时间短（t=2.312，P=0.023）、住院费用低（t=-3.854，P=0.000）。结论 空气气腹LC安全可行，简易价廉，减少CO2排放，减轻CO2气腹术后并发症。

Comparison between Air and CO2 Pneumoperitoneum during Laparoscopic Cholecystectomy

Objective To compare the efficacy of air pneumoperitoneum with CO2 pneumoperitoneum during laparoscopic cholecystectomy （LC） , and to explore the application value of air pneumoperitoueum LC. Methods From July 2013 to October 2013, 109 patients with benign gallbladder disease were assigned to air group （n = 53 ） or CO2 group （n = 56） based on the date of operation. All the instruments used in the air group were exactly the same as the CO2 group except for the gas to build pneumoperitoneum. The complications, pain reaction, postoperative hospital stay, and total hospital cost were compared between the two groups. Results All the procedures were completed successfully in both the groups without conversion to open surgery or serious complications. No patient in air group was converted to CO2 pneumoperitoneum. Compared with the CO2 group, the air group had less incidence of postoperative shoulder pain （X^2 = 4.097, P = 0.043 ） , less incidence of postoperative nausea and vomiting（x2 = 4.584, P = 0.032 ） , lower visual analogue scale scores （ t = - 3.568,P = 0. 000） , shorter postoperative exhaust time （ Z = - 4.287, P = 0.000 ） , shorter postoperative hospital stay（ t = - 2.312, P = 0.023 ） and less hospital cost （ t =- 3.854, P = 0.000 ）. Conclusions Air pneumoperitoneum LC is safe and feasible. It both reduces emission of CO2 and relieves postoperative complications of CO2 pneumoperitoneum LC.